Clinical and MRI features of neurological complications after influenza A (H1N1) infection in critically ill children

Abstract

Fatal neurological complications in children after H1N1 infection include ANE and opportunistic fungal infection. MRI is essential for identification of neurological complications and for clinical evaluation.

Neurological complications after H1N1 influenza vaccination: magnetic resonance imaging findings

“…H1N1 vaccination is an important prophylatic tool to decrease the incidence, intensity, and morbidity of the disease 20 . Cases of different types of encephalitis and myelitis after vaccination against the H1N1 have been described 4,10,11,20,21 . The pathogenesis of this encephalitis is not yet fully explained and is believed that immunemediated alterations resulting in the production of antibodies and/or the emergence of de novo inflammatory process are responsible 20,21,22 .…”

“…Although some encephalitis patients fully recover without any neurological sequelae, about 30% die 8 . In influenzarelated encephalitis neuroimaging studies may be normal, but T2 and T2 FLAIR hyperintense lesions in the white matter and thalami, cerebral edema, hemorrhages, and a pattern similar to that of acute necrotizing encephalitis have been described 9,10 . Vaccination is an important prophylaxis against H1N1 influenza decreasing the infection rate and preventing severe complications 11 .…”

Paediatric Acute Encephalitis: Infection and Inflammation

“…A revised classification schema for IAE has recently been published [6 •• ] which distinguishes syndromes associated with acute onset which are thought to arise from cytokine storm, from those with subacute onset which are hypothesised to arise from aberrant adaptive responses, or those with delayed/late onset where the pathogenesis is unknown. This classification is supported by neuroimaging findings from a small Chinese series of 17 children with severe IAE (H1N1) [38]. Treatment of influenza encephalopathy syndromes is supportive.…”

Bilateral symmetrical basal ganglia and thalamic lesions in children: an update (2015)

“…However, since the description of several adolescent cases and an association with the nvCJD, interest in these rare, slowly progressive and fatal syndromes has increased among pediatricians and the general public [33]. On MRI, basal ganglia alterations in viral and spongiform encephalopathies are most often characterized by restricted diffusion either from primary viral infection or from secondary to virusrelated small vessel vasculopathy and asymmetric involvement of the gray and white matter structures [26,27,32,34]. Lower NAA/Cr has been described in patients affected by sporadic Creutzfeldt-Jakob disease with basal ganglia involvement showing a rapid course of the disease [35].…”

“…The Kayser-Fleischer ring, a darkened brown ring at the junction of the cornea with the sclera, is a distinctive characteristic of Wilson disease. However, Kayser-Fleischer rings are observed less often in the pediatric age group, because they result from the chronic deposition of copper [32,34]. The neurological form of Wilson disease clinically presents with the classic Bwing-beating tremor,^dysarthria, ataxia, and rigidity.…”